Macular Degeneration

Macular Degeneration

Macular degeneration is the leading cause of blindness for people age 55 and older. There are an estimated 10 million Americans living with this incurable eye disease. Macular degeneration is caused by the deterioration of the central portion of the retina, the macula.

This area is the area of the eye that records the images that we see and sends them from the optic nerve to the brain. The macula is responsible for central vision and controls our ability to see fine detail, recognize faces, and our ability to drive a car.

What causes macular degeneration?

Macular degeneration is hereditary, meaning it can be passed on from parents to children. If someone in your family has or had the condition you may be at higher risk for developing the disease. There are two types of macular degeneration:

Dry Macular Degeneration: The “dry” type of macular degeneration leads to thinning and pigment clump formation of the macula. Dry macular degeneration is the most common form of macular degeneration. It tends to progress more slowly than the “wet” type. The amount of central vision that is lost is related to how severely the macula is affected.

Wet Macular Degeneration: With “wet” macular degeneration, abnormal blood vessels grow under the retina and macula. These new blood vessels may then bleed and leak fluid, causing the macula to swell and lift. When this happens central vision becomes distorted. Vision loss may be quite rapid and severe.

Symptoms

a gradual loss of the ability to see objects clearly

objects appear to be distorted in shape and straight lines appear wavy or crooked

a loss of clear vision

a dark area appearing in the center of vision

There is a simple test called Amsler Grid Test that allows you to monitor your vision at home. This tool is important for recognizing and monitoring this disease. It is recommended that the test be done at least twice a week.

Treatment

Currently, there is no curative treatment for “dry” macular degeneration. However, certain vitamin and mineral supplements have been shown to slow its progression. Dr. Fedyk recommends ocular vitamins, which many studies have shown can slow the progression of macular degeneration. If you develop “wet” macular degeneration, it is important that it is discovered early. Certain procedures such as laser or medication injections into the eye can treat and sometimes reverse the damage caused by wet macular degeneration.

Now, a relatively new device, essentially an implantable telescope, is available to offer hope for those “aging eyes.” The U.S. Food and Drug Administration approved the Implantable Miniature Telescope (IMT), which works like the telephoto lens of a camera, in 2010.

The surgical procedure involves removing the eye’s natural lens, as with cataract surgery, and replacing the lens with the IMT. The tiny telescope is implanted behind the iris, the colored, muscular ring around the pupil.

“While it doesn’t cure AMD, it will help improve the vision of patients, and help them resume their favorite activities and independence,”
-Dr. Adam Fedyk.

If are interested in the telescopic lens, please contact Dr. Fedyk and book an appointment at the St. Louis Eye Institute.

Allergic Conjunctivitis

Allergic Conjunctivitis

Allergic conjunctivitis is an allergic reaction on the surface of the eyes. This is an inflammation of the conjunctiva due to an allergy. Common allergens are pollen, dust, pet dander, smoke, mold, and air pollution. There are over 22 million people in the United States that suffer from allergy eyes. These allergies may be seasonal, in the spring and fall when pollen counts are at their highest, or may be year round.

Symptoms

The symptoms may include:

itchy eyes

watering eyes

red eyes

eyelid swelling

Sometimes skin around the eyes can become red and scaly. Many people have more severe symptoms during certain seasons, particularly the spring or fall. Both eyes are usually affected.

Treatment

The first choice for treatment is to avoid the allergy-causing substance(s).

Cool compresses (cool moist washcloths) on your closed eyelids several times a day may help relieve the symptoms. Artificial tear drops may soothe the eyes and wash away allergy-causing particles from the surface of the eye.

Some people require antihistamine or anti-inflammatory pills, especially if they have other allergy symptoms. If you have only eye symptoms, eye drops alone may relieve your symptoms. Antihistamine and anti-inflammatory eye drops can both be used, some of them prescription strength. Some drops may need to be used daily to be effective, while others can be used only as needed.

Dry Eyes

Symptoms

Dry eye is frequently under-diagnosed. The symptoms often develop subtly and are often overlooked until the problem is severe. Dry eye affects women much more frequently than men. Typical symptoms include:

Watery eyes

The feeling of sand or grit in your eyes

A burning sensation, worsened by heated rooms or air conditioning

Vision that becomes blurred after periods of reading, watching TV, or using a computer

Treatment

General measures: Dry eyes can be exacerbated by smoky environments, dust and air conditioning, and by our natural tendency to reduce our blink rate when concentrating. Purposefully blinking, especially during computer use and resting tired eyes are basic steps that can be taken to minimize discomfort. Using a humidifier, especially in the winter, can also help by adding moisture to the dry indoor air.

Artificial tears For mild and moderate cases, supplemental lubrication is the most important part of treatment. Application of artificial tears at least 4 to 6 times per day can provide temporary relief. Unlike other drops, these contain glycerin, a natural compound designed to moisturize and protect the ocular surface of the eye and are free of toxic polymers. Most importantly, these tears contain a chemical called hyaluronate to allow the drop to remain longer in the tear film, giving longer-lasting lubrication and comfort. With each blink of the eye, it re-lubricates to provide prolonged relief.

Artificial tear ointments Lubricating tear ointments such as Tears Again can be used during the day, but they generally are used at bedtime due to poor vision after application. Application requires pulling down the eyelid and applying a small amount inside. Depending on the severity of the condition, it may be applied from every hour to just at bedtime.

Restasis Topical cyclosporine A is an immunosuppressant that decreases surface inflammation. Usually, 1 drop of Restasis is instilled in each eye twice a day. The effects of Restasis on dry eyes do not occur immediately, but an overall relief in dry eye symptoms is most often achieved at 3 to 6 months after the start of Restasis treatment.

Punctal plugs In each eye, there are little openings that drain tears into the tear ducts called puncta. There are methods to partially or completely close the tear ducts. This blocks the flow of tears into the nose, and thus more tears are available to the eyes. Punctal plugs are inserted into the puncta to block tear drainage, mainly for people who have not found dry eye relief with eye drops.

Punctal plug insertion is a painless procedure. Sometimes temporary punctal plugs are placed initially, where a plug that will dissolve quickly is inserted into the tear drain of the lower eyelid. This can be done to determine whether permanent plugs can provide an adequate supply of tears.

If temporary plugging of the tear drains works well, then silicone plugs may be used later on. The plugs will hold tears around the eyes as long as they are in place. Many patients find that the plugs improve comfort and reduce the need for artificial tears.

Glaucoma

Glaucoma

Glaucoma unfortunately steals the vision of thousands of people every year. Glaucoma is a leading cause of blindness in people over 40. However, if glaucoma is diagnosed early, before it has done major damage to the optic nerve, it can be treated. This can prevent vision loss. Damage that has already taken place, however, cannot be reversed. That’s why early detection is so important in treating glaucoma. The onset of glaucoma usually occurs at age 35 or older. Two out of every 100 people in this age group have vision threatened by this disease.

Diagnosing Glaucoma

There are many tests available to assist in diagnosing glaucoma, or monitoring for possible progression of the condition. The St. Louis Eye Institute employs the latest state-of-the-art glaucoma detection technology available. Visual field testing, digital photos of the optic nerves, pachymetry, OCT nerve fiber layer analysis, and electrophysiologic testing are all used to aid in diagnosing glaucoma before vision loss has occurred.

Treatment

At the St. Louis Eye Institute, we use advanced testing equipment to detect glaucoma by testing the pressure of your eye along with testing visual acuity and visual field. It is advised to have regular routine eye exams to detect any changes in your eyesight and determine whether glaucoma has developed in your eye(s).

Treatment to control the disease of glaucoma is critical and includes medications in the form of eye drops or pills, laser surgery and conventional surgery. Once glaucoma is diagnosed, treatment should begin immediately. The best treatment for your individual case will depend on the type and the severity of the disease, which can be discussed during your appointment with Dr. Fedyk.

Corneal Disease

The Cornea

The cornea is a dime-sized clear tissue that is the front of the eyeball. It is the eye’s outermost layer, normally invisible when viewed straight on. It helps direct light rays towards the lens for focusing, and allows light to pass through it to reach the back of the eye.

In order for vision to be clear, the cornea must be clean and clear. Corneal disease can cause the cornea to become opaque or cloudy, preventing light from passing through clearly. Corneal scars, scratches, surface roughness, and irregular curvature will distort vision, and are frequently associated with sensitivity to light.

Fuchs’ Dystrophy

Fuchs’ dystrophy is an inherited eye disease that causes the cells in the endothelium, the last layer of the cornea, to deteriorate. This leads to distorted vision and corneal swelling (corneal edema). This condition affects both eyes and is more common in women than men.

Although this condition is inherited, symptoms do not usually appear until the patient is over the age of 50. Patients with Fuchs’ dystrophy may experience blurred vision as the first sign of this condition. Blurred vision occurs in the morning as a result of fluid accumulating in the cornea while you sleep. As this fluid evaporates throughout the day, vision may improve. Progressive swelling and thickening of the cornea may also lead to painful erosions and difficulty recovering from cataract surgery.

Treatment for Fuchs’ Dystrophy

While there is no cure for Fuchs’ dystrophy, there are several treatment options available to help relieve the symptoms of this condition and to prevent permanent damage. In its early stages, Fuchs’ dystrophy can often be treated with a salt solution to remove fluid from the eye and reduce swelling. In more advanced stages, Fuchs’ dystrophy may begin to interfere with daily activities and prevent patients from functioning normally. In this stage, patients may require a corneal transplant to replace the cornea with full, thick layers that allows them to see clearly. The DSAEK procedure is an innovative partial corneal transplant procedure performed on an out-patient basis.

Keratoconus

Keratoconus is a very rare eye condition in which the normally round, dome-like cornea becomes thin and develops a cone-like bulge. Keratoconus literally means “cone-shaped cornea.” As light enters the cone shaped cornea it is bent and distorted and unable to come to a point of clear focus on the retina, causing blurred vision. Keratoconus can make some activities difficult, such as driving, typing on a computer, watching television or reading. This condition is typically not associated with redness, inflammation or other “acute” symptoms and therefore may go undetected for a long period of time.

Keratoconus usually begins during teenage years. In most patients, it progresses for several years before stabilizing in the third to fourth decade of life. In severe cases it can continue to worsen. In these cases the cornea continues to thin and bulge outward, further blurring vision. Scarring of the cornea can also develop.

Treatment for Keratoconus

The treatment approach to keratoconus follows an orderly progression from glasses to contact lenses to corneal transplantation. Glasses are an effective means of correcting mild keratoconus. As the cornea steepens and becomes more irregular, glasses are no longer capable of providing adequate visual improvement. Contact lenses are the next approach to treatment.

Many keratoconus patients will never require surgery, but it is an option in severe and advanced cases. If Dr. Fedyk determine you have significant scarring of the cornea, he may recommend corneal transplant surgery. In this procedure, the scarred tissue is replaced with a section of donated cornea. About 10 to 20% of keratoconus patients will eventually require a corneal transplant. However, a corneal transplant is not a cure. Following a successful corneal transplant, most patients still need glasses, soft contacts, or RGP contact lenses for adequate vision.

Cataracts

Cataracts

Cataracts, clouding of the natural lens of the eye, are the leading cause of vision loss in adults age 55 and older, and the leading cause of blindness worldwide, according to the National Institutes of Health.

During non-laser cataract surgery, the patient’s natural lens of the eye is removed and replaced with an artificial lens implant using traditional surgical implements and blades. Laser Cataract Surgery allows Dr. Fedyk to perform the cataract surgery without blades of any kind.

Frequently Asked Cataract Surgery Questions

What are Cataracts?

The lens in your eye is normally crystal clear, but when it becomes opaque, we call it a ‘cataract’. A cataract is NOT a film or growth that occurs in the eye, it is simply a cloudy lens. In a normal eye, light passes through the clear lens and focuses on the retina. A clouded lens or cataract causes the light to scatter across the retina.

As the opacity worsens, it prevents light from properly focusing on the retina, the light sensitive tissue lining the back of the eye. Early lens changes or opacities may not disturb vision significantly. But as the lens continues to change, your vision becomes blurred and you may begin to notice glare with car headlights, haziness, and difficulty seeing street signs or reading, for example.

What are the symptoms of cataracts?

Blurry or hazy vision, or dim vision that requires brighter lights in order to read small print

Increased glare and sensitivity to light, especially in bright sunlight or while driving at night

How are cataracts diagnosed and treated?

You’ll need to have a thorough examination of your eyes, including dilation and an attempt at a new glasses prescription. At first, a change in your eyeglass prescription may be all that is needed to temporarily improve your vision. When you feel that your vision affects your daily activities or your lifestyle and you desire better vision, cataract surgery should be considered. Cataracts can only be removed with surgery.

When do you need cataract surgery?

The decision is yours.

There is no single objective test to determine the need for cataract surgery. The final decision to have cataract surgery is always made by the patient, and it depends on how much the decreased vision from the cataract is bothersome.

St. Louis Cataract Surgeon Dr. Fedyk will always explain your status and options to you clearly and let you make your own decision about when to have cataract surgery.

If you are considering cataract removal surgery, here are some factors that you should think about:

Doing cataract surgery at an earlier stage makes for a quicker recovery and a technically easier surgery. Waiting until the vision is very poor can often make the surgery and the recovery more involved.

The Missouri Department of Motor Vehicles requires that drivers have 20/40 vision (with or without glasses) in their better eye to qualify for a license without an eye exam. Some patients choose to wait until their vision is approximately at this 20/40 level. However, nowadays more and more active patients who still work, drive, and use computers have higher demands for their vision. These patients tend to choose surgery at an earlier stage.

Some patients choose to have surgery even before they develop vision-blocking cataracts. For these patients, who are typically in their 50s, refractive lens surgery is performed in order to eliminate or reduce the need for glasses and to regain their near vision. With their astigmatism managed and a multi-focal lens implanted, the vast majority (92% in the official FDA study) of these patients see well at distance, intermediate, and near, and they never or just occasionally use glasses. The remaining 8% also saw quite well, but they used glasses more than just occasionally.

The bottom line is: If you’re happy with your vision and it doesn’t cause difficulties with reading, computer use, driving, working, or your active lifestyle, then you should postpone the surgery. If you want and need better vision for your activities right now, and would like to see more clearly, then schedule your surgery with top Cataract Surgeon, Dr. Adam Fedyk.